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Tuesday, September 27, 2011

Apidra: The Smackdown

Oh Apidra, how I love and loathe thee.

About five weeks ago I switched Grace over from Novolog to Apidra in her OmniPod insulin pump. And things went swimmingly. Highs were coming down faster, we were not seeing a high postprandial spike, and it really seemed to work faster for Grace. I liked it. I saw less insulin being used more productively for her. I changed basals, I:C ratios and correction factors, and all was well. Honestly, all was well for about 3-4 weeks.

Quick synopsis - I realized that Grace may need to change her Pod every 48 hours, because of this issue with Apidra. It was literally conking out at 48 hours in the Pod. Not consistently and not every time, but it's like waiting for the floor to drop out from underneath you. It's like playing Tower of Terror with the pump. Honest, that's what it feels like to me!

This was not sitting well with Grace. She wanted the full three days out of her pump sites and who can blame her? The damn thing hurts when it goes in! I wanted that too, as we got a full three days, and sometimes a few bonus hrs, out of each Pod with Novolog. I told her of my new plan, that we would keep our eyes peeled at the 48 hour mark, and when the numbers started to skyrocket after 48 hours, we would change it. Maybe we would get three days out of a Pod, it had happened before with Apidra. That was our game plan, but really, why is watching your child like a hawk for every hour after the two day mark any kind of rational diabetes management, for anyone frankly?!

Sorry for the little sidetrack...

Which brings us to yesterday.

Grace woke up at a beautiful 125. The magic 48 hour mark was at 12:30 pm.
10:30 am classroom check - 210/190. Hmmmm, little high, suspicion begins.
11:45 am lunch check - 205. OK, well she should not have gone UP since the correction for the 190 happened an hour ago and she's had no food since breakfast
3:30 pm - 410. Crap. Recheck of 388. Double crap. Ketones of .3

I look into the logbook and it hits me. The bewitching hour of 48 hours is past, 3 hours past. That bewitching hour would have been at 12:30 pm today.

It's almost like the Apidra turns to water in her pump after 48 hours.

We change her pump site, and I use the newly opened Apidra, the same vial that I filled this pump with. I attempt a valiant correction of 2 units through her pump, based on the 388 reading. I give her a shot of 1 unit in her arm, from the vial of Apidra, frankly, to prove the point and see if this is really how it goes.

I check 15 minutes later and she is 407. Four frickin oh seven. That is UP!
It's like trying to stop the freight train by sticking your foot out the train door and dragging it on the ground, oh, while wearing flip flops. Nothing good is going to come of it.

I pull Chuck in from outside and say, we need to convene the team here. What's our game plan?
We agree, check in over the next hour and if she has not lowered by at least 30 points, we pull the plug on this pump. We change her site, and we do it with Novolog.

Did I mention this was all happening at dinner time and Grace is starving. I will not let her eat. I give her a mozzarella cheesestick to hold her over. and a piece of chicken. Oh and two slices of ham. And Grace is crying. Cause it sucks to be 388 and climbing. I can SEE it in her, she is not herself.

The next reading? 429.
My friends, that is NOT 30 points lower.

The next reading? 402

The next reading? 399
This is one hour after the correction through the pump AND the arm dose.

Plan goes into action.

One Pod filled with Novolog. Dose of 1.0 unit through the new site. One dose of 1.0 unit given by injection in her arm.

So, now the question is - did some of the Apidra bring her down at all or is this all the Novolog? All I do know is that for close to 3 hours, Apidra did not budge her, at all. It's like it wasn't even being dosed to her. A few thoughts - was she climbing so high that I was just slowing down the high by the dose through the arm, but clearly it wasn't enough to move her down? Did the pump conk out and only the 1.0 unit of Apidra through injection work? Is heat affecting Apidra - her tummy site is a warm place for it. Or was this coming down from the high the work of the new pump filled with Novolog and the 1.0 unit of Novolog through her shot?

I have talked with others about Apidra in their OmniPod. Some are doing great, no problems at all. Some are experiencing the same issue as us - the 48 hour mark spells doom for Apidra in the Pod.

For now, I am out of the ring in the match with Apidra. It's back to Novolog for us for a little bit, until I have the courage to try Apidra again.

I completely understand your frustration! We have experienced a different diabetes situation, but the frustration was the same. You're doing a great job trying to figure it out. Please keep us updated.

why oh why??!!! Isn't it crazy how some things work for some people and some things don't? I makes diabetes just THAT much more frustrating. I hope the novolog does the trick for you guys. keep us posted!

Holy Hell!!! We have been thinking abiut making the Apidra switch but.... Things have been going well since switching to the pod so, if it ain't broke...!! You get it figured Out and then fill me in - Kay??? :)

UGH Penny! I am so sorry to read this. Apidra has been life-changing for us. Joe was only getting 36 to 48 hours out of his sites pre-Apidra (they were infused with Humalog). Now, on Apidra, he gets 3 to 4 days out of each site. It has been amazing. So strange how each of our children react differently to insulins, foods, activities. Another example of YDMV. xo

Here's what I'm thinking.. that the vial of Apidra had gone bad (it is very temperature sensitive). We store Apidra in fride; we do not keep the vial we are currently using at room temperature. Apidra sheet does say to change Apidra in the pump every 48 hrs. We just keep an eye on it after 48 hours. Sometimes we have to change it; sometimes we get another half day out of it; sometimes a fll day. Don't blame you for going back to Novolog; kids don't like to change the set every two days.

I'm sorry I have no words of wisdom here (not that I ever do). I'm just sorry. I hate the stubborn highs. The ones you can't figure out. The shoot me straight down that dark spiral in a hurry. I'll be thinking of you and Grace. We're OPers and I have been considering Apidra too. We use Humalog. And the endos comment there was, why "fix" what isn't broke. But I am so drawn to a lesser spike. I dunno. Just know you aren't alone. Hang in there. It scares me when you are stumped. I learn so much from you. You WILL figure this out . . . cause you're Penny! ;)

Yuck-O! That totally sucks!Bean's been podding Apidra for almost two months and we haven't had the 48 hour issue. It's not terribly hot here ;) but it's kept quite toasty when it's on her tummy. It's a tough call, but those highs that won't come down are worth switching back for now, IMO.Hoping the heavens open and wisdom is imparted...with some singing angels and beautiful rays of light just for effect! ;)Truly am hoping you can figure it out...for you and for Grace!!!

Oh my word Penny! I would have eaten everything in the pantry. Stress-City!! I am so sorry you had such a rough time. I think Grace is so blessed to have you in her corner, giving 110%. It's hard on our kids now, but I pray one day they'll look back and be grateful. I pray....hugs!

Hello all.. So sorry to hear what is going on with Grace. Unfortunately we learn by trial & error with this disease. I have been a diabetic since age 12, I am now 39. I've tried so many types of insulin. My new doctor switched me from Regular insulin to Apidra. At first it was amazing then a few days after taking it I kept getting shortness of breath, stomach cramps, backache and terrible panic attacks.. I did some research and Apidra can cause all those side effects. I switched back to my Regular insulin & surprise I'm feeling better.. So don't fix what's not broke. Hope everything works out.

Came across your blog when I sesrched "apidra sucks"! Lol, bc I HATE it so much! We switched from Novalog to Apidra and took us a long time to figure out that on the third day, his sugars were high. Why? Because our endo told us it was basically the same as Novalog. Well, um NO! I looked up in there info sheet and it plainly says to change resevoir every 48 hours. Went back to Novalog and 2 weeks later am still decreasing his basals bc he needs so much less insulin on Novalog and his sugars are doing so much better. DONT USE APIDRA IN THE PUMP!!! IT SUCKS! :)

I needed MDI (Multiple Daily Injection), which means 1460 injections a year. Meanwhile, insulin pumps(Apidra) require an infusion set change only about every 3 days, or 122 insertions a year.I think that's one of the things I'm most looking forward to about getting a pump......feeling less like a pin cushion!!! If people ask I usually say the injections don't really bother me but if I think about it properly......yes, they do bother me, a lot!!! Only having to stick a needle in myself once every 3 days instead of 4 times a day will be bloody fantastic!!!!!

how you climb up the mountain is just as important as how you get down the mountain. and, so it is with life, which for many of us becomes one big gigantic test followed by one big gigantic lesson. in the end, it all comes down to one word. grace. it’s how you accept winning and losing, good luck and bad luck, the darkness and the light.